1. 產後併發硬脊膜外膿瘍 Postpartum Epidural Abscess
林肇柏
Chao-Po Lin
戴德森醫療財團法人嘉義基督教醫院 婦產部
Department of Obstetrics and Gynecology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan
Objective: Regional anesthesia is almost universally preferred for conventional cesarean delivery. But postpartum epidural abscess is a rare condition.
Case Report: We report a case of epidural infection shortly after epidural analgesia in a 28-year-old nulliparous parturient who was subjected to stated cesarean section because of fetal malpresentation. Epidural morphine was administered for 3 days for postoperative pain control. She began to have constant lower back pain with fever and right leg paralysis on postpartum Day 4. Magnetic resonance image study revealed suspicious epidural abscess formation at L2-3 and subcutaneous swelling in the back. The patient was treated with intravenous antibiotics and emergent operation. The debridment with partial L2-3 right hemilaminectomy was done. The culture revealed ORSA. She recovered her health gradually. Post cesarean epidural abscess was totally treated uncomplicatedly.
Conclusion: Epidural analgesia is safe for cesarean delivery. However, the complicated infection may be a disaster. We discuss the complicated iatrogenic infection, as well as possible causes and preventions.
Fig 1. The X-ray of lumbar-sacral spine showed: Increase radiolucency in upper end plate and lower end plate of L2-L3, L3-4 with disc space narrowing to R/O Schmorl's nodes. Alignment is essentially normal. No evidence of abnormal paraspinal mass.
Fig 2 & 3. The MRI of the lumbar spine showed epidural abscess formation at L2-3 and subcutaneous swelling in back. At L2-3 level, an epidural lesion with elongated intermediate signal intensity and posterior indentation to dural sac, measuring about 1.4 x 0.75 x 4.0 cm, was noted to suspect epidural abscess formation. Subcutaneous soft tissue enhancement in back was noted and extended along the spinous process (might due to infectious process).